Dressing (medical)

 Materials for dressings

These consist of lint, scraped linen, carded cotton, tow, ointment spread on calico, adhesive plaster, compresses, pads, bandages, poultices, old rags of linen or calico, and water. 


 Dressings

These are substances usually applied to parts for the purpose of soothing, promoting their reunion when divided, protecting them from external injuries, absorbing discharges, protecting the surrounding parts, insuring cleanliness, and as a means of applying various medicines. 


Dressings. These may be either dry or wet.

Dry dressings  consist of gauze and bandage or of cotton and collodion (the cocoon dressing.)

The most convenient form in which sterile gauze can be obtained is in small squares in individual envelopes. Large packages are contaminated with the first opening and are inconvenient.

The cocoon dressing is occlusive and should never be applied over an infected area. It is applicable to sensitive areas for protection, and to operated areas not liable to infection.

Protective varnishes, such as collodion, compound tincture of benzoin, or pure ichthyol, are useful where little protection is indicated.

Wet dressings. Two distinct therapeutic actions may be derived from the wet compress, depending upon whether or not an impervious covering is employed. These actions are antiphlogistic  and hyperemic, and these in turn may be either antiseptic  or astringent. The wet dressing, without a covering, is cleansing and heat reducing, because of evaporation. There should be frequent replenishment of the solution in the treatment of any infected wound or where it is desirable to reduce inflammation.

A wet dressing with an impervious covering is contraindicated in the presence of pus, the warmth and moisture of such a dressing being congenial to the growth and to the multiplication of bacteria.

It is evident, therefore, that a wet dressing with an impervious covering can safely be employed only in conditions where the skin is unbroken, such as sprains and bruises.

The two general therapeutic actions, aside from those of causing hyperemia, are antiseptic and astringent. For the relief of pain and for the reduction of inflammation, wet dressings are the most effective form of treatment because (1) they are aseptic; (2) they permit free drainage; (3) no new granulations are disturbed in changing the dressing.

A great many different solutions are used and among these are:

1. sterile water;

2. ordinary saline solution (a teaspoonful of salt to a pint of water);

3. saturated solution of boric acid (prepared by dissolving a teaspoonful of boric acid powder in a pint of water);

4. Thiersch's solution (prepared by dissolving 15 grains of salicylic acid and 90 grains of boric acid in a pint of water);

5. Burow's solution (a solution of aluminium acetate prepared by dissolving 675 grains of alum and 270 grains of lead acetate in a pint of water.U.S.P. formula);

6. solution of bichloride of mercury (varying in strength from 1 to 3000, to 1 to 10000);

7. 2 per cent. solution of creolin or lysol;

8. U.S.P. lead and opium wash;

9. aqueous solution of ichthyol (varying from 5 to 50 per cent. according to the indications);

10. black wash (made by dissolving 64 grains of calomel in a pint of lime water—this solution only being used in luetic cases).

11. white wash (prepared by mixing zinc oxide, 2 drams, solution of subacetate of lead, 3 drams, glycerine, 4 ounces and lime water, 4 ounces);

12. Dakin's solution (hypochlorite of soda), prepared as follows:

chlorinated lime (bleaching powder)200 gm.
sodium carbonate,dry 200 gm.
sodium bicarbonate 80 gm.

Put the chlorinated lime in a 12 litre flask with 5 litres of ordinary water and let stand over night. Dissolve the sodium carbonate and bicarbonate in 5 litres of cold water; then pour this into the flask and shake it vigorously for a minute and let it stand to permit the calcium carbonate to settle. After half an hour, siphon off the clear liquid and filter it to obtain a perfectly limpid product. The antiseptic solution is then ready for surgical use: it contains about 0.5 gm. per cent. of sodium hypochlorite with small amounts of neutral salts. It is practically isotonic with blood serum. Never heat the solution, and always keep it from the light. If in an emergency it is necessary to triturate the chlorinated lime in a mortar, do so only with water, never with the solution of the soda salts.

This solution has been used extensively abroad in the treatment of infections and wounds and has given splendid results.

(A proper quantity of Dakin's solution for office purposes would be about one-tenth of the prescription above given.)